Second National Conference on Health Care for the Poor and Underserved

203 Summary and recommendations SECOND NATIONAL CONFERENCE ON HEALTH CARE FOR THE POOR AND UNDERSERVED Summation Group Members: CHARLES E. WINDSOR1 GEORGE SMITH, M.D.2 CHERYL SLAUGHTER ELLIS, Ph.D.3 HAROLD NEVELS, M.D.4 PEARLINE GILPIN, C.N.M., M.A.4 MICHAEL L. HOWELL, M.D.5 OZELLE L. HUBERT, M.D.6 ROBERT AUSTIN, M.D.7 W EFOUNDTHE conference presentations informative, and more important, provocative. We sincerely commend the faculty and the conveners, Meharry Medical College/Institute on Health Care for the Poor and Underserved . Our comments, which follow, are reflective of thoughts provoked by the presentations and the commitment of those in attendance to involvement in pursuit of improved health care delivery in both the public and private sectors: • On review, it does not appear that the present Administration is offering any new ideas to respond to the critical gap that has developed between the health status of the poor and that of others. • It is also clear that the health care gap is growing at an alarming pace with the rapid expansion of the pool of poor and uninsured. • The lack of uniform standards for health care coverage from state to 'Harlem Hospital, New York, NY 2Bureau of Health Services, Tennessee Dept. of Health and Environment 3Dept. of Health Education, Middle Tennessee State University, Murfreesboro 4Dept of Family Medicine, Meharry Medical College, Nashville, TN 5TaTnPa General Hospital and St. Joseph's Hospital, Tampa, FL 'Pharmacy Technician Program, Malcolm X College, Chicago, IL 'Pediatrician (private practice), Houston, TX Journal of Health Care for the Poor and Underserved, Vol. 1, No. 1, Summer 1990 204 state is a serious and unacceptable impairment to equal distribution of health care services. • The impairment is further exacerbated by the decreasing number and maldistribution of health care providers who are committed to serving the poor. It was noted that decreasing the gap will also require lifestyle changes among the at-risk population. It was observed that motivation toward that end would be strengthened as follows: • Greater sensitivity to the lifestyle patterns of patients who are poor and underserved and more thoughtful and innovative approaches to ways of encouraging needed changes must be developed by providers in consultation with consumers. • Emphasis must be placed on reading, writing, arithmetic, and risk reduction. • Health education and health career motivation must begin at the lowest grade school level and continue through high school and beyond. It was recognized that political support is a sine qua non for addressing the crisis and that support will not be achieved without increasing health status awareness in the general population. To do this, greater involvement of members of the health care provider team in education and assessment was seen as vital and promotion of the team approach was determined to be in order. Team members were defined as nurses, physicians, dentists, various technicians , pharmacists, nutritionists, physician assistants, health educators, chiropractors , social workers, etc. It was thought that we must define health care as more broad than medical care and bring about a recognition that it is in fact: • Health education; • Lifestyle modification; • Nutrition and other health promotion and disease prevention practices. To promote more of a health care team approach to addressing these issues it was suggested that Meharry may wish to consider sponsoring and annual inter-professional conference where role expansion and mutual support could be encouraged, explored, and developed. It was believed that restructuring of the approach to health care should begin with asking the poor and underserved what health care means to them. It was also believed that the role of third-party payers needs to be evaluated in terms of the impact of their policies on coverage and accessibility. As facts were presented by the very distinguished conference faculty on the growing fiscal impact of the cost of AIDS, cancer, STDs, substance abuse, and other afflictions dominant among those least able to pay, it became increasing apparent that the institutions committed to serving that segment of the population were at greatest risk because their financial viability has been seriously undermined by developing policies of third-party payers. A grim picture was thus brought into focus. That focus was further sharpened by projections...